Validation of the Maryland Aggregate Pathology Index (MAPI), a pre‐implantation scoring system that predicts graft outcome

Predicting graft outcome after renal transplantation based on donor histological features has remained elusive and is subject to institutional variability. We have shown in a retrospective study that the Maryland Aggregate Pathology Index score reliably predicts graft outcome. We sought to validate the scoring system in our center and a second transplant center. We analyzed 140 deceased donor kidneys pre‐implantation biopsies from center 1 and 65 from center 2. The patients had a mean follow‐up of 695 ± 424 and 656 ± 305 d respectively. Although MAPI scores were similar, there were significant differences in donor and recipient parameters between both centers. Despite this, MAPI was predictive of graft outcome for both centers by Cox univariate, multivariate and time dependent ROC analysis. For center 1 and 2, three yr graft survival within each MAPI group was statistically equivalent. The three‐yr graft survival at center 1 for low, intermediate, and high MAPI groups were 84.3%, 56.5%, and 50.0%, respectively, p ≤ 0.0001, and at center 2 were 83.3%, 33.3%, and 33.3%, p = 0.006. MAPI, which is based on a pre‐implantation biopsy, demonstrated similar predictive and outcome results from both centers. As expanded criteria donors (ECD) criteria have redefined marginal kidneys, MAPI has the potential to further define ECD kidneys, increase utilization, and ultimately improve outcomes.     

Introduction to a special issue on kidney development and disease

Enriching our understanding of the anatomy of the kidneys, in development, health, and disease, has been the primary focus of Professor John Bertram's distinguished research career to date. Among other notable achievements, his landmark analyses of nephron number in over 400 human kidneys (the Monash Series), and his refinement of stereological techniques for renal structural analyses, have proven him an international leader in renal anatomy research. In this Special Issue, we (some of John's collaborators, colleagues, and former students) celebrate John's career with a series of 20 review and original research articles relevant to his expertise: (a) renal anatomy, physiology, and pathology, (b) kidney development, podocyte biology, and applications of renal stem cells, (c) renal developmental programming, and (d) contemporary methodologies in renal research; his accomplishments as a Head (Chair) of an Anatomy Department are also illustrated. We hope that this collection will serve as both an important resource, and a source of inspiration, to renal anatomy researchers and educators alike.     

Rokitansky sequence in association with the facio-auriculo-vertebral sequence: Part of a mesodermal malformation spectrum?

We report on a 4-year-old first-born mono-zygotic twin girl with a hypoplastic left face, mandible and zygoma, left microtia without an external auditory canal, a U-shaped cleft palate, right ectopic-fused kidneys, a blindly ending vaginal pouch, and absent uterus. We review 3 other cases with the manifestations of the Rokitansky and the facio-auriculo-vertebral sequence. The anomalies in these disorders can be thought of as deriving from an early defect or disruption in fetal mesoderm or its progenitor tissue at the time of primitive streak formation. They are frequently associated with other mesodermally derived defects or sequences and may together represent an extended polytopic field defect. While such speculation on how these spatially separated anomalies develop is probably simplistic, the concept of a mesodermal “malformation” spectrum is helpful in reminding the clinician to look for other mesodermal defects when one mesodermally derived defect or sequence is detected.     

荧光定量PCR检测梅毒螺旋体方法的建立及初步应用

目的采用二聚体蝎型探针技术建立一种高敏感性和特异性的检测梅毒螺旋体(TP)的荧光定量聚合酶链反应(PCR)方法。方法根据TP特异性外膜蛋白Gpd的基因序列设计引物和荧光探针,采用基因工程技术构建可用于TP定量的标准品,优化荧光定量PCR的反应体系和反应条件,建立检测TP的二聚体蝎型探针定量PCR。采用本研究建立方法和商品化荧光定量PCR试剂盒检测40例临床标本,对比分析检测结果的统计学差异。结果成功构建了TP重组质粒标准品和TP的二聚体蝎型探针定量PCR,该方法线性范围为101~108 copy/mL,灵敏度为10copy/mL,特异性和敏感性均为100.0%;二聚体蝎型探针定量PCR对疑似梅毒病例阳性检出率显著高于目前商品化Taqman荧光定量PCR试剂盒(82.5%vs 62.5%,P0.05)。结论成功建立了二聚体蝎型探针荧光定量PCR快速检测TP的方法,为临床上TP的早期诊断和防控奠定了基础。     

双工多普勒超声对Budd—Chiari综合征血流动力学的研究

对１１例Ｂｕｄｄ—Ｃｈｉａｒｉ综合征患者病损血管的血流动力学改变状况应用双工多普勒超声进行了检测。结果显示；Ｂｕｄｄ—Ｃｈｉａｒｉ综合征病损血管的血流双工多普勒超声检测显示有血流方向、速度、血流性质以及频谱形态等一系列改变。双工多普勒超声可以无创地获取Ｂｕｄｄ—Ｃｈｉａｒｉ综合征血流动力学改变的信息，准确反映下腔静脉、肝静脉和门静脉内的血流循环状态，它对临床的病情分析、诊断、治疗和疗效判断均有重要的临床价值。     

腹腔镜手术治疗肝肾囊肿、多囊肝及多囊肾

目的 探讨腹腔镜下肝肾囊肿、多囊肝及多囊肾开窗术的方法及效果。方法 腹腔镜下行肝肾囊肿、多囊肝、多囊肾开窗术15例。结果 15例均痊愈,术后住院3—4天,无并发症。术后随访6月一4年,无复发。结论 腹腔镜肝肾囊肿、多囊肝及多囊肾开窗术创伤小、恢复快、粘连轻,对囊肿复发可再次行腹腔镜囊肿开窗术     

Analyzing the Effects of Heat Treatment on SMAW Duplex Stainless Steel Weld Overlays

Duplex stainless steel (DSS) has a reasonably high resistance to chloride stress corrosion cracking for offshore and marine applications. However, DSS weld overlay has not been successfully demonstrated due to some inherent problems in achieving pitting and crevice corrosion resistance. In this research work, isothermal heat treatments (350, 650 and 1050 °C) with and different cooling rates have been performed DMR249 Grade A by using shield metal arc welding (SMAW) with an E2209 electrode. Micrographs have shown two phase microstructures of the DSS weld metal, the amounts of austenite phase increased with increment of post-weld heat treatment (PWHT) temperatures. The dilution has maintained consistent values except solution annealing that has shown the disappearance of the heat affected zone in micrographs. The weld metal hardness values increased with PWHT temperatures and remained low at solid solution annealing temperatures. The major alloying elements (C, Mo, Cr, Ni, N, and Fe) were analyzed, as these elements can contribute to intermetallic phases. The results showed that C and Cr content slightly increased with PWHT except for solid solution annealing, Mo showed consistently low content due to dilution effects. Ni maintained higher content, although the heat-treated samples showed slight fluctuations. Nitrogen produced consistent values, as recommended to prevent critical involvement in nitride precipitation.     

老年原发性高血压合并无症状性脑梗死的脑血管评估

目的：探讨老年原发性高血压静止性脑梗死与颅内-外动脉狭窄的关系。方法：对86例老年原发性高血压合并静止性脑梗死患者的数字减影血管造影（DSA）和彩色多普勒超声（Duplex）检查资料进行分析。计算颅内-外动脉狭窄率及斑块未检出率，并对DSA和Duplex检查进行比较。结果：86例患者颈动脉颅外段斑块检出率高于正常对照组（62．79％，24．00％，P〈0．01）。86例患者中，单纯颅外动脉、颅内动脉及颅内-外动脉多发性狭窄或闭塞发生率分别为43．02％（37／86）、16．82％（14／86）和27．91％（24／86）。颅外动脉狭窄或闭塞发生率高于颅内动脉（70．93％，44．19％，P〈0．001）。Duplex对颈动脉颅外段狭窄检查结果与DSA差异不显著（P〉0．05）。结论：在老年原发性高血压合并静止性脑梗死患者中，颈动脉颅外段狭窄有较高的患病率。对老年原发性高血压患者定期进行颈动脉Duplex超声检查，可早期发现颈动脉颅外段狭窄并采取相应措施，对预防缺血性脑血管病有重要意义。     

健脾补肾法防治顺铂为主化疗药所致肾功能损害的临床观察（附167例对照分析）

将１６７的用顺铂为主进行化疗的恶性肿瘤患者分为２组，以健脾补肾法观察化疗药物对肾功能的影响。治疗组加用中药健脾补肾方剂，结果治疗组肾功能损害的发生例数低于对照组。两组对比尿素氮（ＢＵＮ）、肌酐（Ｃｒ）有明显差异（Ｐ＜０．０５，Ｐ＜０．０２５），常规有差异，但无显著性（Ｐ＞０．０５）。